After 12 elderly residents of a Broward County rehabilitation center died of heatstroke in September 2017 when Hurricane Irma knocked out power and left them to bake for hours, state officials revamped emergency preparation guidelines for Florida’s 687 nursing homes and 3,062 assisted-living facilities (ALFs).
The result was a revision of the 2004 Emergency Status System (ESS) by the Office of Health Quality Assurance within Florida's Agency for Health Care Administration (AHCA).
Among components of the AHCA’s new ESS is a requirement that all nursing homes and ALFs have back-up generators and adequate fuel to maintain an ambient temperature of 81 degrees for 96 hours after losing power.
The new ESS also features a website that documents the number of beds, generators, dialysis machines and other medical equipment onsite at each nursing home and ALF, with hotlines and Facebook groups for relatives, friends and advocates.
Nursing homes and ALFs were given deadlines to comply with requirements that they meet new standards, especially in providing generators. Between August 2018 and this August, almost 300 facilities had been fined for failing to follow the regulations, according to the AHCA.
The state’s efforts in ascertaining the preparedness of nursing homes and ALFs were augmented by support from the Federal Emergency Management Agency (FEMA).
“We've been moving our supply staff and equipment into Florida, a lot of our planning teams are already embedded with Florida emergency management in Tallahassee,” acting FEMA administrator Peter Gaynor said in an interview with ABC's Good Morning America on Friday. “We'll continue to move our commodities, like generators, in and around the state to make sure the state has no unmet needs. So we'll continue to do that over the weekend and so like the federal family is preparing we encourage family, individuals to take preparations seriously. The clock is ticking.”
The approach of Hurricane Dorian was the first test of how effective the ESS’s capacity to track preparedness would be – and it proved successful in pin-pointing where vulnerable residents could potentially be at risk.
On Friday, nearly 60 percent of Florida’s nursing homes could not verify they had all the proper equipment onsite as required by state regulations, according to the AHCA.
That same day, Gov. Ron DeSantis said 120 nursing homes had not submitted proof that they had generators, as required by the ESS.
“There are going to be site checks, there are going to be phone calls to make sure that they have a plan to deal with folks that are in their care,” DeSantis said, vowing state officials would inspect nursing homes in hard-hit areas immediately after the storm to ensure they have power and adequate supplies.
By Sunday afternoon, DeSantis reported, all nursing home operators in the state’s eastern coastal communities in Dorian’s projected path had assured the AHCA, and documented through the ESS, that they had at least temporary generators onsite or a plan to evacuate should they lose electricity.
On Monday, 2,904 of 3,062 ALFs – covering 86 percent of the state’s 106,254 ALF beds – reported having generators on site. ALFs with 7,301 beds had been given additional time to meet the requirement but 7,762 beds in about 160 ALFs were without generators and an approved “variance.”
By Tuesday night, according to the website, 36 ALFs housing 1,278 beds, about 1.2 percent of the state’s total, had not reported its generator status.
The state’s Department of Emergency Management reported Monday that 72 nursing homes and ALFs, along with seven hospitals, had been evacuated.
AHCA Secretary Mary Mayhew told reporters that four ALFs were evacuated because they didn’t have emergency generators or access to backup power.
“They are making a determination based upon their buildings’ ability to withstand a Category 5 [hurricane], whether they are in the surge zone. So that is separate and apart from the generator,” Mayhew said.
She would not say if evacuated nursing home and ALF residents were being transferred to emergency shelters or special-needs shelters, noting the specific decisions were made by local officials.
“All of the coordination and the decision-making around evacuations are local,” Mayhew said. “Patient safety, our requirements, our expectations around patient safety, remain intact.”